Exploratory Urinary Metabolomics of Type 1 Leprosy Reactions.

BACKGROUND: Leprosy is an infectious disease caused by Mycobacterium leprae that affects the skin and nerves. Although curable by multidrug therapy, leprosy is complicated by acute inflammatory episodes, called reactions, the major cause of irreversible neuropathy in leprosy that occur before, during and even after treatment. Early diagnosis and prompt treatment of reactions reduces the risk for permanent disability.

METHODS: This exploratory study investigated whether urinary metabolic profiles could be identified that correlate with early signs of reversal reactions (RR). A prospective cohort consisting of leprosy patients with and without reactions as well as endemic controls, was recruited in Nepal and urine-derived metabolic profiles were measured longitudinally. Thus, we extended a conventional area of biomarker identification for leprosy towards noninvasive urine testing.

RESULTS: For the first time in mycobacterial diseases it was found that the urinary metabolome can be used to discriminate endemic controls from untreated patients. Moreover, metabolic signatures in urine of patients developing RR were clearly different before RR onset compared to those at RR diagnosis.

CONCLUSION: This study indicates that urinary metabolic profiles are promising host biomarkers for detecting intra-individual changes during acute inflammation in leprosy and can contribute to early treatment and prevention of tissue damage.